Tear Trough Restylane Injections

Tear trough rejuvenation a non-surgical treatment, is appropriate for some patients with lower eyelid dark circles/dark hollows (also referred to as “tear troughs” or “tear trough defects”).

In the lower eyelid a weakening of the orbital septum, and in the cheek area (the “mid-face”) a loss of soft tissue volume, tend to accentuate the appearance of the lower bony orbital margin which lies between the lower eyelid and the cheek. This also leads to the appearance of lower eyelid fat pockets and together these can lead to a “tear trough” depression, or dark shadow or hollow.

Not all patients who complain of lower eyelid dark circles or lower eyelid dark hollows are suitable for surgical improvement, usually in the form of cosmetic eyelid surgery (a lower eyelid blepharoplasty or eye bag removal). The use of Restylane injections offers some patients a less invasive alternative treatment than cosmetic eyelid surgery for their problem as shown in the photographs (see photos). Some patients also benefit from Restylane Sub-Q or Juvéderm Voluma injections which help to restore a youthful shape to the face by filling the inner and outer part of the upper cheeks as shown in example 2 (see photos). This patient has also undergone anti-wrinkle botulinum toxin injections to her forehead with an improvement in her forehead lines and her brow shape. She has not undergone cosmetic eyelid surgery.

Although the use of Restylane as a soft tissue filler in other areas of the face is very well established and associated with high patient satisfaction, its use for the management of “tear troughs” (or hollow eyelids or lower eyelid dark circles) and, with Restylane Sub-Q or Juvéderm Voluma, the management of a loss of soft tissue volume in the mid-face, is proving to be a very good new application for many patients. The effects of the injections last approximately 6-12 months before repeat injections are required. For some patients the effects can last longer.

Some patients benefit from a combination of cosmetic eyelid surgery (blepharoplasty) and tear trough injections and/or cheek dermal filler injections. Your surgeon will be able to advise about the best option for you.

Tear Trough Restylane Injections

The treatment is undertaken as an outpatient procedure that can offer immediate cosmetic results, a reduced risk of complications that are associated with cosmetic eyelid surgery (lower eyelid blepharoplasty) and a very short recovery period. Restylane Sub-Q or Juvéderm Voluma can also be injected in the cheeks. Dermal fillers can be injected as a trial without removing the option of a lower eyelid blepharoplasty at a later stage. The treatment is associated with mild discomfort and a short "down time". The injections also contain lidocaine, a local anaesthetic, which helps to minimise any discomfort. Bruising and swelling usually take a few days to subside.

Tear trough rejuvenation is now undertaken using a specially designed blunt-tipped cannula  (the Pix'Lcannula).

The Pix’L Micro Cannula

The introduction of the Pix’L range of Micro Cannulas for use with Restylane, Perlane and subQ hyaluronic acid (HA) facial rejuvenation treatments offers the advantages of less pain, fewer complications and less downtime when compared with a standard needle injection technique. Whereas a needle may pierce delicate structures (such as blood vessels) the Pix’L cannula has a blunt tip that will push these structures to one side without injury to them as it is advanced.

The Pix’L cannula is designed to deliver a thin smooth thread of hyaluronic acid filler. This reduces the chance of a lumpy appearance because the delivery is more precise and controlled.

This is of particular benefit in specialist treatments around the eye such as tear trough rejuvenation. The Reinforced Pix’L cannula has been designed to deliver precise threads of HA filler in this area where the skin and subcutaneous tissues are thin. The risk of lumpiness, bleeding (haematoma) and injection into a blood vessel in the tear trough area is much reduced.

Advantages of the Pix’L cannula:

  • Reduced pain – The Pix’L cannula does not puncture tissues like a sharp needle. Instead it glides smoothly along the tissue planes without injury to adjacent structures. There is less pain and swelling as a result.

  • Less tissue trauma – The smooth outline and blunt tip of the Pix’L cannula make injury to  tissues much less likely. This reduces the risk of blood vessel injury and bruising and swelling.

  • Reduced complications – The Pix’L cannula delivers a precisely controlled fine thread of HA filler and so reduces the risk of a lumpy appearance compared to a needle.
Moreover the Pix’L cannula virtually eliminates the risk of inadvertently injecting the filler into a blood vessel. Although extremely rare, this can result in very serious complications such as loss of vision. The Pix’L cannula therefore offers a major potential safety advantage over a standard needle technique. 

  • Reduced downtime – You are less likely to have any significant bruising or swelling after treatment with the Pix’L cannula and so can often resume your daily routine activity immediately after treatment.

Click here to watch a short video about the Pix’L cannula.

In order to minimise the risk of bruising it is advisable to discontinue the use of Aspirin, Anadin or any anti-inflammatory medicines e.g. Indomethacin, Ibuprofen, Diclofenac, Voltarol, for 2 weeks before treatment, provided it is medically safe to do so (please discuss this with your GP or physician if in doubt about this).

Excessive bruising can lead to staining of the Restylane gel in the lower eyelids and a blue discolouration of the skin although this occurs very infrequently. Occasional contour irregularities can occur following the injections. These are managed with massage after applying Auriderm (link to www.faceandeyeshop.co.uk) cream.

On the very rare occasion that a patient is unhappy with the results, the filler can be dissolved away with the use of a small injection of Hyalase (an enzyme commonly used in local anaesthetic solutions given around the eye in patients undergoing cataract surgery). 

Pretreatment considerations

You will visit the clinic to have a preoperative consultation. This usually lasts 30 minutes. (Some patients prefer to schedule the treatment on a separate occasion – if you prefer to undergo the treatment on the same day you will need to make this clear when you book the appointment with your surgeon). You will need to provide information before attending (see below).

You will be asked to complete a healthcare questionnaire, providing information about your current and past health, about any previous eye, eyelid or facial surgery or treatments including refractive surgery or laser eye surgery, and any previous non-surgical aesthetic treatments e.g. Botox injections, dermal fillers injections, the use of IPL or laser treatments. We need to know if you have a past history of any eye problems e.g. dry eyes, or if you use contact lenses. We need to know about any allergies you may have, medications you are taking (including over the counter products e.g. Aspirin, Indomethacin, Nurofen, Diclofenac or vitamin supplements), previous major surgery or illnesses, any past dermatology history and whether or not you smoke. You may have your blood pressure checked by the nurses at the clinic.

It is very helpful if you have old photographs which you can bring along to the consultation. If you are happy to email digital photographs of your current appearance in advance of the consultation with details of your concerns, this is also enormously helpful and saves time. Your photographs will be kept confidential and will form part of your clinical record.

If you are unsure of the names of any medications, bring them with you.

You will be told whether or not to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure as long as these are not medically essential. You might need to check this with your GP. Any anti-inflammatory medicines e.g. Ibuprofen, Nurofen should be discontinued at least 2 weeks before surgery. These medicines predispose you to excessive bleeding. You will be given a leaflet advising you on what medications, foods, and vitamin supplements to avoid prior to the treatment. Your blood pressure should also be under good control if you take medications for hypertension. This is very important.

If you can, try to stop smoking at least six to eight weeks prior to the treatment. Smoking has an adverse effect on healing and damages your eyelid skin and supporting tissues and your eyes (it can result in premature cataract formation and age related macular degeneration with a loss of central vision).

Photographs of your face and eyelids will be taken before your treatment so that the results of your treatment can be compared with your original appearance. The photographs are confidential and can only be used for any purpose other than your own records with your specific written permission.

The risks and potential complications of the treatment should be considered but these need to be kept in perspective. Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimize any risks.

What are the possible complications of tear trough injections?

Most complications of the treatment are minor and are amenable to successful treatment.

Complications from tear trough injections include:

  • Infection
  • Bruising and swelling of eyelids
  • Contour irregularities
  • Redness of the eyelids
  • Tenderness
  • Very rare: a localized allergic reaction in the form of firm swelling at the injection site. This has been seen in approx 1:10,000 patients, and may occur a few days up to several weeks after the injection. They may last a couple of weeks up to several months in rare instances. Prolonged firmness, abscess, formation, scarring, or a grey discolouration may occur in less than 1:15,000 cases, lasting several months.
  • Damage to the eye or eyesight including blindness from this procedure is an extremely remote risk in the hands of a specialist oculoplastic surgeon. All precautions are taken to minimize such a risk.
  • Blue discolouration over the injections can occur in some patients.
  • Further treatment. Further injections within the first 1-2 weeks to address any asymmetries or undercorrection may be required.


What is the post treatment care?

After the injections it is advisable to avoid rubbing the eyes, lifting weights or straining for a few days. Vigorous gym work should be avoided for a few days.

Make up should be avoided for 48 hours.

It is helpful to apply Auriderm cream to the tear trough areas and to undertake gentle side to side massage twice a day for a week. This can be purchased from Face & Eye or online from the clinic’s online shop (www.faceandeyeshop.co.uk).

You are advised to sleep with the head raised approximately 30 degrees to help to minimize any eyelid swelling.

Contact lenses can still be worn following this type of surgery.

Click here for further information about the cost of tear trough rejuvenation injections.






Before tear trough injection Before tear trough injection
After tear trough Restylane injections After tear trough Restylane injections
Before tear trough injections Before tear trough injections
After tear trough Restylane injections After tear trough Restylane injections
Before tear trough injections Before tear trough injections
After tear trough Restylane injections After tear trough Restylane injections
Before tear trough injections Before tear trough injections
After tear trough Restylane injections After tear trough Restylane injections
Before tear trough injections Before tear trough injections
After tear trough Restylane injections After tear trough Restylane injections

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What our patients say

"...the results have been far better than I could have ever imagined! My eyelid is practically symmetrical to my other eye which is a prospect I would never have expected to experience again." Read what Mr HW says